7.2 Administration and governance
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Overall responsibility for general supervision of the health system is held by the Ministry of Health. The ministry is involved in drafting legal acts and issuing regulation for the health sector. It also runs health care facilities and public health institutions and has the overall responsibility of health system performance. In addition, the Ministry of Health develops health care infrastructure and prepares national health programmes. In conjunction with the Ministry of Economy and the Ministry of Finance, it makes decisions on major investments. The main aims of the Ministry of Health are the development, organisation, coordination and control over the implementation of state policy in four fields: individual health care, public health, pharmaceutical activities and health insurance. Other major functions of the Ministry of Health include drafting legal acts, licensing, implementing state policy in subordinated institutions, formulating and implementing health strategies and programmes, international collaboration, analysing and disseminating information, and handling patients’ complaints. In addition, many institutions subordinate to the Ministry of Health have been established in order to carry out regulatory and governing functions. In 2001, the Ministry of Justice established a Prison Health Care Division in charge of overseeing health-care provision in all prisons in cooperation with the Ministry of Health. Also there are the Health service office and Medical Centre under the Ministry of Interior in Lithuania.
The National Health Insurance Fund (NHIF) implements the state health insurance scheme . The NHIF mission is to ensure access to health care, for those who are insured (emergency health care is provided for all Lithuanian citizens), by remunerating the costs and using funds. The NHIF coordinates the activities of five existing territorial health insurance funds. The central NHIF office is in charge of budget planning and control, including decisions on the financial reserves, supervision, and audit of the territorial branches. The territorial branches of the NHIF sign contracts with health care providers and pharmacies. The branches also reimburse health care providers and pharmacies, disseminate information, control service provision in the regions, and finance municipal public health programmes. Supervisory boards of territorial NHIF branches have advisory functions and consist of representatives from the Ministry of Health, the central NHIF and the municipalities.
The eight budgetary institutions under the Ministry of Health have specialized functions: State Forensic Psychiatry Agency, National Public Health Surveillance Laboratory, Centre for Communicable Diseases and AIDS, State Mental Health Centre, Centre for Health Education and Disease Prevention, Nursing Training and Specialization Centre, the Lithuanian Medical Library and the Institute of Hygiene. National Health Board Among the national level institutions is in charge of health policy implementation, the National Health Board, which is subordinate to parliament, plays the most active role. The board consists of representatives from municipal health boards, universities, NGOs and public health professionals. The National Health Board coordinates public health policy areas while the municipal health boards implement health policy at the local level.
Starting in 1990 many health administration functions in Lithuania were decentralized from the Ministry of Health to the municipalities. Municipalities are responsible for organizing, and have a wide range of responsibilities in the implementation of local health programmes and public health activities. The municipality board approves health programmes and sets health budgets, while the director of administration ensures health programme implementation. Since 2006 Municipal Public Health Bureaus have provided public health services to municipality residents.
Other public bodies which are responsible for health promotion and primary prevention are institutions under the Minnistry of Health which include: the Centre for Health Education and Disease Prevention, and the Institute of Hygiene. Centre for Health Education and Disease Prevention activity areas include noncommunicable diseases and injury prevention, child health, health promotion, physical activity and nutrition, environmental health and health specialist training. The Institute of Hygiene activity areas include: monitoring of health and its factors at the population level; researches on health inequalities and work environmental effect on health; health technology assessment in public health and occupational health; developing and testing innovative interventions in public health; evaluation of health strategies and measures of programmes. The Drug, Tobacco and Alcohol Control Department, under the Government of the Republic of Lithuania, is the main institution responsible for tobacco and alcohol control. The State Mental Health Centre, which engages in implementation of mental health policy and public mental health measures, including coordination of primary mental health care and monitoring and strengthening population mental health. Other institutions include the: Communicable Disease and AIDS Centre, Health Emergency Situation Centre, National Public Health Care Laboratory, and State Mental Health Centre.
Municipal Public Health Bureaus (Visuomenes sveikatos biurai) are established in each municipality that act as municipal public health care institutions. The Bureaus are the main institutions at the local level. Each municipality has to have a bureau or otherwise buy these services from another municipality. The Bureaus, as a public body, are responsible for health promotion, public health monitoring, communicable disease prevention, prevention of non-communicable diseases and injuries, implementation of public health programmes in the municipal community, child and youth health promotion, and evaluations of the effect of the decisions of municipalities on public health. The functions of the Municipal Public Health Bureaus are established by the Ministry of Health, which among other programmes include municipal public health support programmes for youth. Public health care provided by municipalities is financed from the state budget, the municipal budget, the municipal public health support program, the Compulsory Health Insurance Fund and other funds. In accordance with the procedure established by the Government, the municipalities report annually to the Ministry of Health. The functions of the Municipal Public Health Bureaus may include 1) organizing and coordinating the activities of public health professionals working in general education schools or vocational schools; 2) organizing and coordinating student health promotion activities; 3) training of public health care professionals in schools; 4) providing methodical consultations for health activities to teachers, pupils, their parents (carers, caretakers), and residents of the municipality; 4) organizing public health education courses; 5) providing information, counseling and methodological assistance to the urban communities; 6) the implementation of programs approved by the Lithuanian Health Program, state health programs and approved by the the municipality; 7) drafting reports and analyses; 8) providing health care at schools, help students protect and enhance their health through the organization and implementation of measures for the prevention of diseases and injuries.
Article 6 of the Law on Public Health Care of the Republic of Lithuania (Lietuvos Respublikos visuomenės sveikatos priežiūros įstatymas) states that public health care functions at pre-school, pre-primary, primary, basic and secondary education programs in pre-school, general education schools and vocational education institutions in the territory of the municipality, public health strengthening, public health monitoring are designated to municipalities. The municipalities carry out independent public health care functions such as: 1) implemening public health measures provided for in the strategic development plans of the municipality and (or) municipal strategic plans approved by the municipal council, taking into account the prevailing public health problems in the municipality; 2) participate in the implementation of state public health programs, interinstitutional activities plans; 3) carry out the health care of children and young people, except for public health care provided by pre-school, pre-primary, primary, basic and secondary education programs in pre-school, general education schools and vocational education institutions located in the municipality's territory; 4) includes social partners in public health promotion activities.
Among voluntary organizations, the Red Cross Society, the Caritas Federation, the Diabetes Association, the Association of the Blind have been influential in public debates. There are about 80 patients’ organizations, 30 of them united in the Council of Representatives of Patients’ Organizations. Another umbrella organization is POLA, established in 2011, which unites 12 NGOs working in the area of oncology. The National Tobacco and Alcohol Control Coalition works in the area of tobacco and alcohol use. The Diabetes Association provides mutual aid and assistance to all diabetics; promotes the study, the spread of knowledge and the proper treatment of diabetes; removes all present limitations of diabetics discrimination in their rights to labour, studies, insurance. The Lithuanian Heart Association helps those who are suffering from heart disease, and those who want to avoid it, improves Doctors' professional skills, informs society.
The need to ensure better and more efficient cross-sectoral dimension in the youth and health field is widely acknowledged. The Inter-institutional Action Plan under the horizontal priority “Health for all” within the National Progress Programme 2014–2020 was adopted by the Government in 2014, with focus for coordinated measures aimed at improvement and development child and youth friendly, high quality, accessible and effective healthcare, with particular focus on public health and inter-sectoral cooperation. In general the Department of Youth Affairs within the the Ministry of Social Security and Labour is primarily responsible for youth and/or youth programming and this includes cross-sectorial mechanisms of cooperation. The Department of Youth Affairs coordinates and organizes committees on monitoring specific policy measures while the Ministry of Social Security and Labour is responsible for coordinating the implementation of the National youth policy development program for 2011-2019 through Action Plan for the period of 2017-2019. In this Action Plan specific objectives, actions, terms of implementation, budget allocations and responsible institutions for its implementation are indicated.
Collaboration between ministries and stakeholders does exist to varying degrees and on different levels. Intersectoral committees have successfully been set up to manage ongoing policy processes. In general, the The Ministry of Social Security and Ministry of Health handles youth and health issues. The institutional landscape in the field of youth and health is large. There is a lot of institutions and health bureaus in municipalities taking care of specified tasks and activities that relate to youth and health. In some areas, clarity is lacking on the potential overlaps and/or redundancies when different actors work in closely similar areas. The cross-sectoral dimension in youth health is implemented through collaboration by the Ministry of Social Security and Labour, the Ministry of Health, the Ministry of Education and Science, and the Department of Physical Education and Sports under the Government of the Republic of Lithuania. This cross-sectorial dimension includes coordination and implementation of youth sports and health policy measures. Municipal Public Health Bureaus (Visuomenes sveikatos biurai) are established in each municipality that act as municipal public health care institutions. The Bureaus are the main institutions at the local level. Each municipality has to have a bureau or otherwise buy these services from another municipality. The Bureaus, as a public body, are responsible for health promotion, public health monitoring, communicable disease prevention, prevention of non-communicable diseases and injuries, implementation of public health programmes in the municipal community, child and youth health promotion, and evaluations of the effect of the decisions of municipalities on public health. The functions of the Municipal Public Health Bureaus are established by the Ministry of Health, which among other programmes include municipal public health support programmes for youth.The coordination and implementation of youth sports and health policy measures is based on the Interinstitutional Action Plan for the implementation of the state sports development strategy for 2011-2020.